"When you get those rare moments of clarity, those flashes when the universe makes sense, you try desperately to hold on to them. They are the life boats for the darker times, when the vastness of it all, the incomprehensible nature of life is completely illusive. So the question becomes, or should have been all a long... What would you do if you knew you only had one day, or one week, or one month to live. What life boat would you grab on to? What secret would you tell? What band would you see? What person would you declare your love to? What wish would you fulfill? What exotic locale would you fly to for coffee? What book would you write?"
Sunday, July 22, 2012
Another WIN for Therapeutic Modalities
So this post stemmed from last night at work. Here's the situation:
My patient had a total abdominal hysterectomy approximately 2 days before she was under my care. Under report I learned that she had not had a bowel movement since surgery (but this is common with recent abdominal surgery), and that she has having a lot of bloating and pent up gas cramps/pain. When I first saw her, she was having some intense nausea. However she had just received a one time dose of morphine, which can very often cause some intense nausea, especially depending on how its given. She also received a PO (by mouth) dose of percocet (she was in a lot of pain). Percocet can also cause nausea. So I decided to give it a little while and told her I would come back.
Well, not ten minutes later is she throwing up, but not much. I still attributed it to the recent doses of narcotics and helped her clean up and decided just to keep an eye on it. However about thirty minutes later she was in intense nausea again, so much so that she couldn't stand up, and was vomiting. My mind started reeling....is there an obstruction? As with any abdominal tampering, its possible to get an unfortunate bowel obstruction. If severe enough, this would then cause anything that's in your intestines above the blockage to come out upwards because it has no where else to go. Keep in mind that she was promoted to a regular diet, just as of the previous day.
So keeping in mind the very real possibility that we were facing an obstruction and may be putting in an NG tube (this would drain out the contents from your intestines above the obstruction), I didn't want to scare her so I didn't even mention it yet. She was already having enough anxiety from her pain and nausea.
Then a thought occurred to me....I always try and put myself in patients shoes. I have had my own very extensive share of gastrointestinal problems and have a lot of experience with different therapeutic techniques, both with western and alternative therapy.
So despite the fact that I've been blessed enough to have never had abdominal surgery, I have had my fair share of "gas issues", especially thanks to my ever so lovely lactose intolerance. So I thought, what do I do for gas cramps/pain?
I went in the room and asked if anyone had taught her the "Left side trick". She looked at me strange because I pretty much made up that phrase on my own, but what else do you really call it in a quick bundle? She obviously said no and I then proceeded to have her lay on her left side and massage her entire abdominal wall in a clockwise motion, slowly and rather firmly (but not enough that it hurts). This follows the natural pathway of your intestines and helps guide the gas out the exit door, so to speak. If you're super lucky, it may even promote the probability of having a bowel movement, in addition to the gas passage increasing the then probability of a bowel movement.
So I had her concentrate on this technique, as I so often do when I'm in gas pain. I also encouraged her to take some deep breaths, and to remain on left side, while also in the fetal position. I find that in the fetal position, the pressure of your knees against your abdomen also helps guide things out the exit door, and....well, it "opens up" the exit door completely, making it that much easier to pass gas.
Now for the epic result?? I checked back in about thirty minutes after that education time, and I honestly didn't have much faith in my alternative non-medication therapies. I came in offering a powerful anti-emetic that she was now eligible to receive, but turns out? She was feeling much better already. Her nausea had receded slightly and the gas cramps were improving. Win!
Even more win, when I went to go to check on her in the middle of the night, I heard some unexpected news that she actually passed gas! Woot! She even managed to pass a very tiny (but one all the same!) bowel movement. Woo hoo! A + for non-medication therapies, for the win!
I couldn't believe it worked. I mean, I thought everyone knew that trick. I thought it was an old age wive's tale, or whatever they call it. I learned the trick in a mother-baby class in college, when we were taught how to alleviate gas in babies. I assumed it would work for adults, and its always worked for me and now for my patients too! :)
So, thanks for reading through a rather gaseous post.....it can be helpful if you also suffer at times! Who the heck doesn't??! Admit it. You probably just farted. Yeah, I just said fart.
Anyway, like I said, I'll try to post more upcoming! Stay tuned....
With Love, WNB